Allergic rhinitis – commonly known as hay fever – is an allergic response to specific allergens. An allergen is a harmless substance that causes an allergic reaction. The condition develops when the body’s immune system is sensitized and over reacts to something in the environment that typically causes no problems in most people. It refers to inflammation inside the nose caused by allergens such as pollen, dust, or flakes of skin from certain animals. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), about 8 percent of adults in the United States suffer from allergic rhinitis of some kind. It is estimated that between 10-30 percent of the worldwide population may also have allergic rhinitis. Allergy specialists or other physicians dealing with patients suffering from this condition must provide adequate treatment and also ensure that the medical coding for this specific disorder is properly done on the medical claims. Using the right medical codes for documenting the symptoms, diagnosis and treatment of this allergic disorder is crucial for accurate processing of medical claims. Outsourcing billing and coding tasks to a reliable medical billing and coding company can help physicians submit their medical claims without errors.
In most cases, when your body comes in contact with allergens, it happens to release histamine – a natural chemical that defends your body from the allergen. This chemical substance can cause allergic rhinitis and related symptoms. Common allergens include – tree pollen, grass pollen, dust mites, animal dander (which is old skin), cat saliva, mold, pet hair and other irritants such as cigarette smoke, perfume and diesel exhaust.
Types of Allergic Rhinitis
There are two different forms of allergic rhinitis – seasonal and perennial.
- Seasonal – As the name suggests, seasonal allergic rhinitis usually occurs at the same time every year. It is typically caused by an allergy to pollen or mold spores in the air. Pollen is the fine powder that comes from the stamen of flowering plants. It can be carried through the air and is easily inhaled.
- Perennial – Perennial allergic rhinitis is non-seasonal and occurs any time of the year. The condition is caused by other allergens such as dust mites, pet hair or dander, or mold and symptoms can occur year-round.
Allergies can affect anyone, but a person is more likely to develop allergic rhinitis if there is a history of allergies in his/her family. Having asthma or a topic eczema can increase their risk of suffering from this condition. Other potential risk factors include – wood smoke, wind, perfume/hair spray, cigarette smoke, fumes, colognes, cold temperatures, chemicals and air pollution.
Symptoms
The signs and symptoms of allergic rhinitis can vary, depending on the type and severity of your allergies. Common symptoms include –
- Sneezing and coughing
- Watery, red, or swollen eyes
- Trouble smelling
- Sore throat
- Runny/stuffy nose
- Pressure in the nose and cheeks
- Itching (mostly eyes, nose, mouth, throat and skin)
- Hives
- Frequent headache
- Ear fullness and popping
- Dark circles under your eyes
Patients in most cases experience one or more of these symptoms immediately after coming into contact with an allergen. On the other hand, certain symptoms like recurrent headaches and fatigue may only happen after long-term exposure to allergens. It is important to consult an allergy specialist if the symptoms last for more than a few weeks and do not seem to be improving.
Treating Allergic Rhinitis
For patients who happen to experience minor allergies, diagnosis may begin with a physical exam. The physician may ask questions about the immediate symptoms and evaluate previous medical history. Keeping a record of the symptoms over a period of time can help the doctor determine what triggers the allergies.
A skin prick test is one of the most common tests for diagnosis. As part of the test, the physician may place several substances onto the patient skin to analyze how the body reacts to each one of those substances. Physicians will observe and record the way the patient’s skin reacts to each allergen. In most cases, a small red bump may appear in cases where a person is allergic to a substance.
In addition, blood test and radioallergosorbent test (RAST) may also be advised. The RAST measures the amount of immunoglobulin E antibodies to particular allergens in the blood and determine which specific substance a person is allergic to. Once the nature of allergens is identified, physicians can decide on the future treatment options.
Treatment options for the condition involve a combination of medications and home remedies and possibly alternative medicines. Medications to treat allergic reactions include: –
- Antihistamines (over-the-counter (OTC) antihistamines like fexofenadine (Allegra), diphenhydramine (Benadryl), desloratadine (Clarinex), loratadine (Claritin), levocetirizine (Xyzal) and cetirizine (Zyrtec)
- Decongestants (prescribed for a short period, usually no longer than three days, to relieve a stuffy nose and sinus pressure. These include – oxymetazoline (Afrin nasal spray), pseudoephedrine (Sudafed) and cetirizine with pseudoephedrine (Zyrtec-D).
- Eye drops and nasal sprays
Other therapies include – immunotherapy or allergy shots and sublingual immunotherapy (SLIT – involves placing a tablet containing a mixture of several allergens under the tongue). In addition to these treatments, following certain home remedies can help prevent the allergy and this again will directly depend on the type of allergens. Using a dehumidifier or a high-efficiency particulate air (HEPA) filter can help control allergies while indoors.
Allergy and sleep medicine medical billing and coding is challenging and involves using the specific ICD-10 diagnosis and CPT procedure codes to report allergic rhinitis on the medical claims. The symptoms, diagnosis and treatment procedures offered by allergy specialists and other physicians must be documented using the correct medical codes. The following medical codes are used for billing allergic rhinitis –
ICD-10 Codes
- J30 – Vasomotor and allergic rhinitis
- J30.0 – Vasomotor rhinitis
- J30.1 – Allergic rhinitis due to pollen
- J30.2 – Other seasonal allergic rhinitis
- J30.5 – Allergic rhinitis due to food
- J30.8 – Other allergic rhinitis
- J30.81 – Allergic rhinitis due to animal (cat) (dog) hair and dander
- J30.89 – Other allergic rhinitis
- J30.9 – Allergic rhinitis, unspecified
CPT Codes
- 86003 – Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each
- 86005 – Allergen specific IgE; qualitative, multiallergen screen (eg., disk, sponge, card)
- 86008 – Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each
- 9500 – Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
- 95017 – Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests
- 95018 – Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests
- 95024 – Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
- 95027 – Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests
- 95028 – Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
- 95044 – Patch or application test(s) (specify number of tests)
- 95052 – Photo patch test(s) (specify number of tests)
- 95056 – Photo tests
- 95070 – Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with histamine, methacholine, or similar compounds
- 95071 – Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with antigens or gases, specify
- 95076 – Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance); initial 120 minutes of testing
- 95079 – Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance); each additional 60 minutes of testing (list separately in addition to code for primary procedure)
- 95115 – Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection
- 95117 – Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections
- 95144 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial(s) (specify number of vials)
- 95145 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom
- 95146 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 2 single stinging insect venoms
- 95147 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 3 single stinging insect venoms
- 95148 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 4 single stinging insect venoms
- 95149 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 5 single stinging insect venoms
- 95165 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)
- 95170 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses)
- 95180 – Rapid desensitization procedure, each hour (e.g., insulin, penicillin, equine serum)
- 95199 – Unlisted allergy/clinical immunologic service or procedure
The outcome of the treatment depends largely on the severity of the condition. In most cases, seasonal allergies usually aren’t severe and can be well managed with medications. However, severe forms of this condition require long-term treatment. One of the best ways to prevent allergy symptoms is to manage the allergies before one’s body has a chance to respond to substances adversely. Other home tips to manage allergies include – keeping the windows and doors shut as frequently as possible during the allergy season, covering the mouth and nose while performing yard work, staying indoors when pollen counts are high, avoiding exercising outdoors early in the morning and taking a shower immediately after being outside.
Medical billing and coding for allergic rhinitis can be complex, as there are different codes associated with the condition. By outsourcing these tasks to a reliable medical billing service provider that offers the services of AAPC – certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.